Patients with serious illnesses who have prioritized healthcare objectives and whose doctors are aware of them are probably in a better position to get the care that is goal-concordant. For a study, researchers sought to assess the percentage of critically sick patients whose clinicians properly perceive their priority healthcare objective and pinpoint the elements contributing to accurate perception.
It was a secondary study of a multicenter cluster-randomized trial involving doctors and outpatients with life-threatening illnesses. Two weeks following a clinic visit, patients and physicians reported their current prioritized healthcare goals: either extending life over relieving pain and discomfort or relieving pain and discomfort over extending life, respectively. Matching these items characterized correct perception.
Of 252 patients with a prioritized healthcare goal, 60% had their objective appropriately interpreted by their clinician, 27% had their treatment provided by clinicians who thought the alternative goal should have priority, and 13% had an unresolved question from their clinician. Goals were more likely to be appropriately recognized in patients who were older (OR 1.03 per year; 95% CI 1.01, 1.05), had consistent objectives (OR 2.52; 95% CI 1.26, 5.05), and had recently discussed their goals of treatment (OR 1.78; 95% CI 1.00, 3.16).
Most critically ill outpatients receive care from professionals who correctly understand their patients’ top healthcare priorities. However, a sizeable number were not and may be more vulnerable to treatment that is not in line with their goals. Since recent talks were linked to accurate perceptions of patients’ prioritized objectives, interventions that enable goals-of-care dialogues may help align treatment with goals.